Delayed Discharges in NHS Scotland

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1 Publication Report Delayed Discharges in NHS Scotland Figures from ober Census Publication date 25 November A National Statistics Publication for Scotland

2 Contents Introduction... 2 Background... 2 National Targets Associated with Delayed Discharges... 2 Code 9s... 3 Presentation of Results... 3 Recently Published Data... 3 Changes in Recording Practice... 3 Related Health and Social Care Information... 4 Key points... 5 Results and Commentary... 6 Bed Days Occupied by Patients Ready for Discharge and Code 9 Cases... 6 Trends in Delayed Discharges... 9 Reasons for Delay Trends Short Stay Delays Type of Location of Delay Code 9 Cases Glossary List of Tables Contact Further Information Rate this publication A1 Background Information A2 Publication Metadata (including revisions details) A3 Early Access details (including Pre-Release Access) A4 ISD and Official Statistics

3 Introduction A delayed discharge is a hospital inpatient who has been judged clinically ready for discharge by the responsible clinician in consultation with all agencies involved in planning the patient s discharge and who continues to occupy a bed beyond the ready for discharge date. It is very important that, while the clinician in charge has ultimate responsibility for the decision to discharge, the decision must be made as part of a multi-disciplinary process and focuses on the needs of the individual patient. These patients are clinically ready to move on to a more appropriate care setting either within or out with the NHS, for example patient s home, care home. This publication summarises the latest quarterly census results on delayed discharge patients. It reports on patients who were judged to be clinically ready for discharge but who were still occupying a bed on the census day in ober. It also presents the number of bed days occupied by delayed discharge patients during the period y to September. The publication has been designed to support local agencies in the arrangements they make for the patient s timely, appropriate and safe transfer to the next stage of care. The information contained in the publication is used for a variety of purposes including: Monitoring policy obligations both locally and nationally Helping to troubleshoot in partnership areas with specific problems Facilitating benchmarking with other areas Identifying the potential release of resources to focus on more appropriate care Providing useful dialogue between health and social care agencies Background For most patients, following completion of health and social care assessments, the necessary care, support and accommodation arrangements are put in place in the community without any delay and the patient is appropriately discharged from hospital. A delayed discharge occurs when a patient, clinically ready for discharge, cannot leave the hospital because the other necessary care, support or accommodation for them is not readily accessible and/or funding is not available e.g. to purchase a care home place. National Targets Associated with Delayed Discharges Prior to il, the national target was that no patient should be delayed in hospital for longer than 6 weeks from when they were clinically ready for discharge. The current target, which came into effect in il, stated that no patient should wait more than 4 weeks from when they are clinically ready for discharge and, subsequently, by il 2015, no patient should wait more than 2 weeks as a delayed discharge. These delay periods are the national standard delay periods which are applied to delays. The tables that accompany this publication include information to support the new targets. 2

4 Code 9s It is recognised that there are some patients whose discharge will take longer to arrange and therefore the standard maximum delay is not applicable (see paragraph above for maximum standard delay periods). These cases are classified as Code 9s and would include patients delayed due to awaiting place availability in a high level needs specialist facility and where an interim option is not appropriate, patients for whom an interim move is deemed unreasonable or where an adult may lack capacity under adults with incapacity legislation. Code 9 cases are reported separately in this report to differentiate them from those cases where the standard maximum delay period applies. Presentation of Results This report presents information on the number of delayed discharges for the following geographical areas: Scotland, NHS Board (of treatment) and Local Authority. Recently Published Data In addition to the census data, additional information has been gathered on the number of bed days occupied by all patients experiencing a delay, not just those delayed at a particular census point. This information has been gathered as part of the national reporting requirements recommended by the Delayed Discharge Expert group and agreed by the Cabinet Secretary. Link to tables and charts on the ISD Website Link to bed days occupied tables and charts Link to census tables and charts - Standard delays Link to census tables and charts - Code 9 delays Changes in Recording Practice The national target for delayed discharges specifically for those patients in short stay/acute specialties was dropped in. Figures on these delays were previously included in this report. Information on short stay/acute specialties can be found at the following link: When the above target was dropped there was still a requirement to publish data on those patients with a delay of under three days. In May the Delayed Discharges Definitions and Data Recording Manual was revised to incorporate these changes, which will have an impact on the overall number of delayed discharges and trend information. Any impact resulting from the changes outlined has been highlighted in the relevant tables. The 3

5 recording manual and a summary of the changes to the manual can be found at the following link: Discharges/Guidelines/ From the y census onwards, the publications include patients who were delayed between one and three days prior to the census date. Previously these patients were not counted as part of the census. Therefore, the figures for the total number of patients delayed and those delayed up to two weeks cannot be compared directly with earlier censuses unless any delays of three days or less are removed. This can be done by choosing the specific delay period (which excludes 1-3 day delays) from the drop down menu within the tables. Link to all figures/tables Related Health and Social Care Information ISD publishes other information that helps to measure the shift in the balance of care to ensure that older people are cared for in their own homes or in a homely setting in the community, wherever possible. The Scottish Care Home Census publication looks at the provision of care home places throughout Scotland and for individual local authorities. Trend data is available from March A link to the latest report can be found here: Homes/Census/ The NHS Continuing Care Census identifies all patients who were receiving NHS care on the census date. NHS Continuing Care is defined as on-going, non-acute care, delivered as an inpatient, and often over an extended period, either in hospital, hospice or care home. In addition to supporting the need for information about shifting the balance of long term care for older people, this data is also used to inform on the application of the NHS Continuing Health Care guidance. A link to the latest report can be found here: Continuing-Care/ In June, in response to concerns raised in the media regarding the application of the NHS Continuing Health Care guidance contained in CEL 6(2008) by Health Boards in Scotland, the Cabinet Secretary for Health and Wellbeing commissioned an independent panel to review the delivery, monitoring and governance of NHS Continuing Healthcare in Scotland. The independent review of NHS Continuing Care was published in May ( and makes a number of recommendations about how this type of care is provided, including recommendations about the data collection method. The Scottish Government have accepted the recommendations and committed to review the current guidance in time for implementation from il The Scottish Government publishes other information relating to service provision for older people and this can be found at the following website: 4

6 Key points During the quarter y to September, 154,588 bed days were occupied by delayed discharge patients. This compares with 149,226 during the quarter il to June and 126,531 during the quarter y to September. At the ober census, 321 patients were delayed over four weeks. This compares with 274 at the y census and 156 at the ober census. There were 215 patients delayed for over six weeks at the ober census. This compares with 175 at the y census and 100 at the ober census. At the ober census, 587 patients were delayed over two weeks. This compares with 518 at the y census and 383 at the ober census. The principal reason for delay may change during an individual s period of delay as arrangements for discharge are put in place. The principal reasons supplied for those who had been delayed for more than four weeks at the ober census (321 patients) were as follows. Awaiting place availability in a care home 145 patients. Waiting to go home 90 patients. Awaiting community care assessment 34 patients. Awaiting funding for a care home placement - 13 patients. Awaiting healthcare arrangements - 11 patients. Other reasons such as disagreements 28 patients. There were 334 patients reported as Code 9 delays where the current maximum delay does not apply. Of these, 58 per cent were due to the Adults with Incapacity Act. 5

7 Number of bed days Information Services Division Results and Commentary Bed Days Occupied by Delayed Discharge Patients The total number of bed days occupied by delayed discharge patients in NHS Scotland in the period y to September was 154,588 compared to 149,226 in the previous quarter (il to June ), an increase of over 3%. Figure 1 shows the trend in total quarterly number of bed days occupied by delayed discharge patients from y to September. During this period, the total number of bed days attributable to standard delays increased by 30%, while code 9 delays increased by 14%. Standard delays have increased from 95,527 bed days in y September to 124,338 in y - September, while code 9 delays have increased from 26,421 to 30,250 bed days for the same period. Figure 1: Total number of bed days occupied by Delayed Discharge patients in Scotland by Quarter; y to September 180, , , , ,000 80,000 60,000 40,000 20, Sep Dec Mar Jun Sep Dec Mar Jun Sep 14 Quaterly period Code 9 Standard Source: ISD Scotland Link to all bed days occupied figures/tables 6

8 Number of occupied bed days Information Services Division Figure 2 shows the total number of bed days occupied by delayed discharge patients from y - September and provides a breakdown by age group and type of delay i.e. standard (where the standard maximum delay applies) and Code 9 delays. Figure 2 shows that, on average, there are approximately 37,100 occupied bed days for the 75+ age group and around 14,500 occupied bed days for the age group per month between y and September. This equates to almost three quarters of bed days occupied by delayed discharge patients aged 75 and over. Eighty five per cent of bed days occupied for delayed discharge patients aged 75+ are attributable to standard delays compared to almost 70% for patients aged 18 to 74 years. Figure 2: Number of Bed Days Occupied by Delayed Discharge Patients in Scotland by Month, Category and Age Group: y to September 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5, years 75 + years years 75 + years years 75 + years Aug Sept Month and Age Group Code 9 Standard Source: ISD Scotland Link to all bed days occupied figures/tables 7

9 Comhairle nan Eilean Siar Aberdeen City City of Edinburgh East Lothian South Lanarkshire Highland Shetland Glasgow City Midlothian Scotland Falkirk Fife Aberdeenshire Perth & Kinross West Dunbartonshire North Lanarkshire South Ayrshire Moray Argyll & Bute Angus Dundee City Stirling Scottish Borders North Ayrshire West Lothian Clackmannanshire East Ayrshire Inverclyde Dumfries & Galloway East Renfrewshire East Dunbartonshire Orkney Renfrewshire Rate per 1,000 population aged 75 and over Information Services Division Figure 3 shows the annual rate of bed days occupied by delayed discharges aged 75+, per 1,000 population aged 75+, for the year ober to September by Local Authority area. The rate for Scotland is approximately 1,000 bed days per 1,000 population aged 75+. Renfrewshire and Orkney have the lowest rates (less than 400 bed days per 1,000 population aged 75+) while Comhairle nan Eilean Siar and Aberdeen City have the highest rates (over 2,100 bed days per 1,000 population aged 75+). Figure 3: Rate of bed days occupied by delayed discharges per 1000 population; aged 75+ years; by Local Authority; ober to September 2, Delayed Discharge Bed Day Rate per 1,000 population aged 75+ by Local Authority 2,200 2,000 1,800 1,600 1,400 1,200 1, Local Authority Source: ISD Scotland, based on mid year population estimates More detailed information on bed days occupied can be found in the glossary and following tables: Link to all bed days occupied figures/tables 8

10 Number of patients Information Services Division Trends in Delayed Discharges It is useful to compare the current quarter with the previous quarter s census data, to observe recent changes, as well as with the same census point in the previous year (to remove any potential seasonal effect). Figure 4 shows that at the ober census there was a total of 947 delayed discharges (excluding code 9 and delays of three days or less) in Scotland. This compares to 894 in y and 746 in ober. In relation to the national targets (see page 2) Figure 4 shows that: At the ober census there were 360 patients delayed from 4 days to 2 weeks. This compares with 376 at the y census and 363 at the ober census. At the ober census 587 patients were delayed over 2 weeks. This compares with 518 at the y census and 383 at the ober census. At the ober census there were 321 patients delayed over 4 weeks. This compares with 274 at the y census and 156 at the ober census. The national target is for no patient to be delayed more than 4 weeks. Two Health Boards had no delays over 4 weeks at the ober census. At the ober census there were 215 patients delayed over 6 weeks. This compares with 175 at the y census and 100 at the ober census. A more detailed breakdown by NHS Board and Local Authority can be found: Link to all figures/tables. Figure 4: NHS Delayed Discharges (excluding code 9s and delays of 3 days or less) by Delay period; Scotland; ober 2010 to ober >3 days and up to 2 wks (4 days to 14 days) 2 to 4 wks (15 to 28 days) 4 to 6 wks (29 to 42 days) over 6 wks (43 days and over) Source: ISD Scotland Link to all tables and charts 9

11 Number of Patients Information Services Division Reasons for Delay Trends Figure 5 gives the breakdown for delays over 4 weeks by reason for delay. The principal reason for delay may change during an individual s period of delay as arrangements for discharge are put in place. For example, awaiting assessment may be the first identified principal reason for a patient and subsequently the principal reason may change to awaiting the finalisation of safe discharge arrangements. There were 321 patients in ober who were delayed over 4 weeks. This figure includes 215 patients delayed over six weeks. The main reason for delay is Awaiting place availability in a care home (145 patients (45%)). The other reasons were reported as Patients waiting to go home (90 patients (28%)), Awaiting Community Care Assessment (34 patients (11%)), Awaiting funding for a care home placement (13 patients (4%)) Awaiting healthcare arrangements (11 patients (3%), and Other reasons (28 patients (9%)). In comparison, at the ober census, of the 156 patients delayed over four weeks waiting to be discharged the main reasons for delay were reported as Awaiting place availability in a care home (80 patients (51%)), Patients waiting to go home (44 patients (28%)), Awaiting Community Care Assessment (13 patients (8%)), Awaiting funding for a care home placement (1 patient (less than 1%)) Awaiting healthcare arrangements (1 patient (less than 1%), and Other reasons (17 patients (11%)). Figure 5: NHS Delayed Discharges Over Four Weeks by Reason for Delay; Scotland; ober 2010 to ober Other 300 Healthcare Arrangements Awaiting place availability in a care home Awaiting funding for a care home placement 100 Patients waiting to go home Census Community Care Assessment reasons Other includes Legal/Financial, Disagreements and other patient/carer/family related reasons. Source: ISD Scotland Link to all tables and charts 10

12 Number of Patients Information Services Division Figure 6 shows the breakdown for over 6 week delays by reason for delay. At the ober census, of the 215 patients waiting to be discharged who were delayed over 6 weeks the main reason for delay was reported as Awaiting place availability in a care home (100 patients (46%)) which is similar to the proportion of those delayed over 4 weeks. The other reasons were reported as Patients waiting to go home (61 patients (28%)), Awaiting Community Care Assessment (19 patients (9%)), Awaiting funding for a care home placement (9 patients (4%)), Awaiting healthcare arrangements (8 patients (4%) and Other reasons (18 patients (8%)). In comparison, at the ober census, of the 100 patients waiting to be discharged the main reason for delay was reported, as Awaiting place availability in a care home (48 patients (48%)) which, like ober, is also similar to the proportion for those delayed over 4 weeks. The other reasons were reported as Patients waiting to go home (33 patients (33%)), Awaiting Community Care Assessment (5 patients (5%)), Awaiting healthcare arrangements (1 patients (1%),and Other reasons (13 patients (13%)). No patients were recorded as Awaiting funding for a care home placement. Figure 6: NHS Delayed Discharges Over Six Weeks by Reason for Delay; Scotland; ober 2010 to ober Other Healthcare Arrangements 150 Awaiting place availability in a care home 100 Awaiting funding for a care home placement 50 Patients waiting to go home Census Community Care Assessment reasons Other includes Legal/Financial, Disagreements and other patient/carer/family related reasons. Source: ISD Scotland Link to all tables and charts Short Stay Delays From y delays of between 1 and 3 days were gathered as part of the delayed discharge census (see note in the Introduction). At ober there were 99 delays between 1 and 3 days, compared to 47 at y. 11

13 Number of patients Information Services Division Reasons and Duration of Delay at the ober census Figure 7 demonstrates that the principal reason for delay depends partly on how long the individual has been delayed at the census point. For instance the principal reason for delay for 53 per cent of patients who had been delayed two weeks or less at the ober census point was Awaiting a Community Care Assessment. For those patients who had been delayed over 4 weeks, only 11 per cent of patients were Awaiting a Community Care Assessment. The percentage of patients awaiting place availability in a care home was 18 per cent for those patients delayed less than 2 weeks compared to 45 per cent for those patients delayed over 4 weeks. More detailed information on reason for delay information at Scotland, NHS Board and Local Authority level can be found here: Link to all figures/tables Figure 7: NHS Delayed Discharges Numbers by Principal Reason Group and Duration of Delay 1 ; Scotland; ober census Other Healthcare Assessment / Arrangements Awaiting funding for a care home placement Patients waiting to go home Awaiting place availability in a care home 50 Community Care Assessment reasons 0 1 to 3 days >3 days to 2 >2 to 4 weeks >4 to 6 weeks More than 6 weeks weeks Duration 1 1. Duration calculated from Ready for Discharge Date to the present census date. Other includes Legal/Financial, Disagreements and Other patient/carer/family related reasons. Source: ISD Scotland Link to all tables and charts 12

14 Number of Patients Information Services Division Type of Location of Delay Figure 8 shows that at the ober census, 411 (39%) of delays were in an acute hospital location, compared to 606 (58%) in a community location. Figure 8: NHS Delayed Discharge Patients by Type of Location of Delay 1 and Delay Period; Scotland; as at ober Community (GP led) Community (not GP led) Care Home (NHS contracted bed) Acute 0 > 6 weeks delay > 4 weeks delay > 2 weeks delay 2 weeks or less Delay Period 1. Definitions used for the type of location of delay in figure 8: Acute - Delay location is in the specified list of Acute hospitals found in Link to all tables and charts Care Home - Delay location is an NHS funded bed in a Care Home Community (GP led) Delays that are assigned to the specialty "GP other than obstetrics" Community (not GP led) Delay location is not in the list of Acute hospitals (see above), is not a care home and the delay is not assigned to the specialty GP other than obstetrics 13

15 Number of patients Information Services Division Code 9 Cases As mentioned earlier in this report on page 3, Code 9 cases are those for which the standard maximum delay is not applicable. In ober, there were 334 patients reported as Code 9 delays. Of these, 58 per cent were due to the Adults with Incapacity Act, 20 per cent were due to Patient exercising statutory right of choice, where an interim placement is not possible or reasonable, and the remaining 22 per cent were either Awaiting place availability in a specialist residential facility, Awaiting completion of complex care arrangements in order to live in their own home or Awaiting bed availability in other NHS hospital/specialty/facility. Figure 9 presents the reason and duration of delay for all Code 9 cases. It shows that for each duration of delay category, delays due to the Adults with Incapacity Act is the most common reason for delay. In ober, 88 (26%) Code 9 patients had been delayed for less than 6 weeks and 59 patients (18%) had been delayed for more than 6 months. Figure 9: Number of Code 9 Patients Ready for Discharge Delayed in Scotland, by Reason 1 and Length of Delay (including delays of 3 days or less); ober Awaiting place availability in Specialist Residential Facility Awaiting completion of complex care arrangements in order to live in own home Patients exercising statutory right of choice where an interim placement is not possible or reasonable Patients delayed due to the Adults with Incapacity Act 0 up to 6 wks 6 wks - 12 wks 12 wks - 6 mths over 6 mths Duration of delay 1. The Specialist Residential Facility reason codes have been grouped together. This figure includes delays of 3 days or less. Source: ISD Scotland. Link to all tables and charts 14

16 Number of patients Information Services Division Trend in Code 9s Figure 10 shows trend data for Code 9 delays along with the reason for delay. It shows the total number of Code 9 delays has increased by 8 percent since ober 2010 and shows an increase of 19 percent since ober. The most common reason for Code 9 delays over time is Patients delayed due to the Adults with Incapacity Act. Since ober 2010 the number of these delays has fallen by 9 per cent and shows an increase of 25 percent since ober. The second most common reason for Code 9 delays is Patient exercising statutory right of choice which has increased by 24 per cent since ober The number of patients Awaiting place availability in Specialist Residential Facility (under 65) has increased by 123 per cent since ober 2010 and by 53 per cent since ober. Figure 10: Number of Code 9 Patients Ready for Discharge Delayed in Scotland (excluding delays of 3 days or less), by Reason for Delay; from ober 2010 to ober Awaiting completion of complex care arrangement - in order to live in own home Code 9 patients delayed (no secondary code) Awaiting bed availability in other NHS hospital/ specialty/ facility Awaiting place availability in Specialist Residential Facility (65+) 150 Awaiting place availability in Specialist Residential Facility (under 65) Census Patients exercising statutory right of choice where an interim placement is not possible or reasonable Patients delayed due to the Adults with Incapacity Act Please note that from y onwards there was no longer a category for Code 9 - no secondary code. From y a new code was introduced for patients Awaiting completion of complex care arrangements in order to live in their own home As this figure shows trend information it does not include delays of 3 days or less as introduced from the y census. Further information can be found in tables 8 and 9 - Link to all tables and charts Source: ISD Scotland 15

17 Glossary Delayed Discharge A delayed discharge is experienced by a hospital inpatient who is clinically ready to move on to a more appropriate care setting but is prevented from doing so for various reasons. The next stage of care covers all appropriate destinations within and out with the NHS (patient s home, nursing home etc). The date on which the patient is clinically ready to move on to the next stage of care is the ready for discharge date which is determined by the consultant/gp responsible for the inpatient care in consultation with all agencies involved in planning the patient s discharge, both NHS and non-nhs (Multi-Disciplinary Team). Thus the patient is ready-for-discharge, but the discharge is delayed due to: Social care reasons Healthcare reasons Patient/Carer/Family-related reasons. Bed Days Occupied The number of bed days occupied is gathered for all patients (aged 18 years and over) who have met the criteria for a delayed discharge for each month of the previous quarter e.g. in ober, data on bed days occupied will be collected in the preceding y, August and September. In order to ensure consistency, a midnight bed count approach is applied to each delay episode to determine which particular days should contribute to the bed day count. The ready for discharge date (RDD) is not counted, as the first midnight occurring in the delay episode is attributable to the day after the RDD. The discharge date (the date the delay ended) is counted as the assumption is that the patient was delayed at 00:00 on that day. The following applies to calculating bed days occupied for delayed patients: Count all days that occur between the ready for discharge date (RDD) and the discharge date (the date the delay ended) Do not count the ready for discharge date (RDD) Do count the discharge date (the date the delay ended) For example, if the RDD of a patient was on the 1st of the month and the delay ended on the 5th, the number of days delayed is 4 and the days counted in this delay are the 2 nd, 3 rd, 4 th and 5 th. The number of bed days occupied by some patients delayed under the Adults with Incapacity Act (AWIs, code9/51x) were undercounted for the following quarterly reporting periods, Jun, Sep and Dec, due to a technical problem with the system used to record delayed discharges. This affected the number of bed days in those periods attributed to specific Code 9/51X delays where the ready for discharge date has been updated during the reporting period. The estimated undercount for the ober to December figures was less than 2% of the total quarterly number of bed days. This issue was rectified from uary onwards. 16

18 Patients delayed more than the standard maximum delay period It has been agreed for non-short stay facilities that there is a period of 4 weeks beyond the clinically ready for discharge date during which all assessment and follow-on arrangements are expected to be put in place. During this period the completion of the community care assessment may take place and the patient may be discharged from hospital the patient may be transferred to another health specialty if their assessed need determines this the patient may be transferred to another health specialty to await discharge from hospital. Ready for discharge date Ready for discharge date is the date on which a hospital inpatient is clinically ready to move on to a more appropriate care setting. This is determined by the consultant/gp responsible for the inpatient medical care in consultation with all agencies involved in planning the patient s discharge, both NHS and non-nhs (Multi-Disciplinary Team). The Team must be satisfied that it is safe and reasonable to transfer/discharge the patient. A patient who continues to occupy a hospital bed after his/her ready-for-discharge date experiences a delayed discharge. Reason This is the reason why the patient has remained in the bed awaiting the finalisation of arrangements for his/her safe transfer. For the national census, the principal reason that applies to each patient at the census point is recorded. Community Care Assessment Community care assessments are undertaken by health and social care professionals. The aim of community care assessment is to assess the needs of patients in community settings and recommend how they would best be met. This might include getting special equipment/adaptations to the home, getting help with certain tasks (e.g. dressing, preparing meals) or moving to alternative accommodation where a person can receive more help and support. It is important to note that early referral to social work for community care assessment and early allocation of referral to an appropriate member of social work staff is emphasised as good practice if a prompt discharge is to be achieved. Duration This is the period of time from when the patient was deemed ready for discharge until the census point that the patient has remained in the bed awaiting the finalisation of arrangements for his/her safe transfer. Code 9s Code 9 was introduced in y 2006, following discussions between ISD, the Scottish Government, health and local authority partners. Several conditions were agreed to be applied to the collection and presentation of delayed discharge data. This code was introduced for very limited circumstances where NHS Chief Executives and local authority Directors of Social Work (or their nominated representatives) could explain why the discharge of patients was out with their control. These would include patients delayed due to awaiting place availability in a high level needs specialist facility where no facilities exist and where an interim option is not appropriate, patients for whom an interim move is 17

19 deemed unreasonable or where an adult may lack capacity under adults with incapacity legislation. Adults with Incapacity (AWI) Patients who are deemed clinically ready for discharge but need to remain in hospital because they are going through the Guardianship Order process are recorded as Adults with Incapacity Act (Code 9/51X) within the Delayed Discharges Census. It is recognised these patients may generally experience a delay longer than that which would normally be expected due to the required legal processes and procedures encountered in these cases. Information on the recording and use of this code within the Delayed Discharges Census can be found in the Delayed Discharges Data Definitions and Recording Manual. Guidance on discharging patients who may lack capacity from hospital is in the good practice guide discharging patients who may lack capacity. Statutory Right of Choice Delays in hospital can be due to patients exercising their statutory right of choice, often over the destination of their ongoing care. For example a patient may want to go to a particular care home but is not able to do so because it has no spare places. Further information on this can be found at the following link: 18

20 List of Tables Table No. Name Time period File & size Workbook 1a DD_oct14_tables_charts_A_standard.xls See below Excel [4Mb] Tab 1 Tab 1a Tab 2 Tab 3 Tab 4 Tab 5 Tab 6 These tables and charts present information over time on delayed discharges by length of delay. The table provides an option to select an NHS Board/Local Authority and to make comparisons with another NHS Board/Local Authority. Historical trend of delayed discharges (excluding code 9s and delays of 3 days or less) These tables and charts present information over time on delayed discharges by length of delay. The table provides an option to select an NHS Board/Local Authority and a target. This chart presents trend information on delayed discharges patients by the principal reason for delay. The table provides an option to select a specific delay period (i.e. all delays, six weeks, four weeks) as well as an NHS Board or Scotland as a whole. This table presents information from the current census on delayed discharges by the principal reason for delay. The table provides the option to select a delay period (i.e. all delays, >4 weeks, >6 weeks). This table provides a comparison between the current census, the last quarterly census, and the census in the previous year for that month. The table provides the option to select a delay period (i.e. all delays, >4 weeks, >6 weeks) and a principal reason group for delay. This table provides a breakdown of the reasons for delay at Scotland level. It provides the option to select a delay period to 2001 to 2010 to 2010 to 2010 to to 2010 to Tab 7 Tab 8 This table provides information on the duration of delay at Scotland level. This table provides information on the type of location of delay at Scotland and HB level to to 19

21 Workbook 1b DD_oct14_tables_charts_B_code9.xls See below Excel [3Mb] Tab 9 This table provides trend data for Code 9 patients (see Glossary for definition). This table provides trend data by type of code 9 patient and by delay period. Tab 10 Tab 11 Tab 12 Workbook 2 Table 1 Trend Table 2 by Age and Reason Table 3 Bed Day Rates Chart 1 This table provides Scotland level data on Code 9 patients by reason of delay. This table provides Scotland level data on Code 9 patients for the latest census period. This table provides information on the type of location of delay at Scotland BedDays_Occupied_Tables_To_Sept_20 14.xls Bed Days Occupied by Delayed Discharge Patients by Month, Quarter, Age Group, Reason and Health Board/Local Authority Bed Days Occupied by Delayed Discharge Patients, Quarterly Figures By Age Group, Reason and Health Board/Local Authority Bed Days Occupied by Delayed Discharges Patients - Rate per 1000 population aged 75+, by Health Board/ Local Authority Number of Bed Days Occupied by Delayed Discharge Patients by Month, Reason and Age Group. Available by Health Board/Local Authority to 2010 to to Sept - Sept - Sept - Sept - Sept Excel [2Mb] Chart 2 Number of Bed Days Occupied by Delayed Discharge Patients by Health Board/Local Authority and reason. Available by month/quarter and age group. - Sept Chart 3 Percentage Standard and Code 9 Bed Days Occupied by Delayed Discharge Patients by Health Board and Local Authority. Available by time period and age group. Sept Chart 4 Number of Bed Days Occupied by Delayed Discharge Patients by Month and reason. Available by Health Board/Local Authority and age group. - Sep 20

22 Contact Lisa Reedie Principal Information Analyst Martin McKenna Senior Information Analyst Further Information Further information can be found on the ISD website Rate this publication Please provide feedback on this publication to help us improve our services. 21

23 Appendix A1 Background Information 22

24 A2 Publication Metadata (including revisions details) Metadata Indicator Publication title Description Theme Topic Format Data source(s) Date that data are acquired Release date Frequency Timeframe of data and timeliness Continuity of data Revisions statement Revisions relevant to this publication Description Delayed Discharges in NHSScotland This report provides information on the number of bed days occupied by delayed discharges patients and the latest statistics on NHS hospital inpatients "ready for discharge" but whose discharge has been delayed, from a census of these patients. Figures are shown for Scotland, NHS Board area of treatment and Local Authority. Health and Social Care Access and Waiting Times PDF and Excel ISD Scotland, Delayed Discharges Bed Days Occupied and Quarterly Census. The bed days occupied information gathered is the number of days occupied by delayed discharge patients in the preceding quarter. The quarterly census takes place on the 15th of the month. Prior to the il census partnerships were able to select a date up to 7 calendar days prior to the 15 th and were required to inform ISD is their census was undertaken on a date other than the 15 th. Under no circumstances can NHS Boards undertake the census out with these timescales. The last Tuesday of the month following the census. Quarterly The publication is considered timely. In May the Delayed Discharges Definitions and Data Recording Manual was revised to incorporate these changes and may have an impact on the overall number of delayed discharges and trend information. Any potential impact resulting from the changes outlined will be highlighted in the relevant tables. The y and subsequent censuses include patients who were delayed between one and three days prior to the census date. Previously these patients weren t included in the census. Historic data is not revised and there are no planned revisions of the data. This publication has no revisions 23

25 Concepts and definitions Relevance and key uses of the statistics Accuracy Completeness Comparability Accessibility Coherence and clarity Value type and unit of measurement Disclosure Official Statistics designation UK Statistics Authority Assessment The data definition manual is published at Social-Community-Care/Delayed-Discharges/Guidelines/ Key uses of Delayed Discharges information include: contribution to service planning, quality improvement and evidence based medicine, potential cost savings, supporting research activities, and providing comparative information. The data is considered accurate. The data is validated locally and ISD carry out further validation checks on it in consultation with NHS Boards. The data is then updated if required. 100% of the data is used for analysis. Not comparable out with Scotland. It is the policy of ISD Scotland to make its web sites and products accessible according to published guidelines. All Delayed Discharges PDF reports are accessible via the ISD website at Topics/Health-and-Social-Community-Care/Delayed- Discharges/ In addition the tables and charts presented in the most recent reports are presented within an Excel workbook. Number of people delayed. Number of bed days occupied by delayed patients. The ISD protocol on Statistical Disclosure Protocol is followed. National Statistics. Last published 26 August Next published 24 February 2015 Date of first publication 4 December 2000 Help Assessment undertaken in November by UK Statistics Authority. Date form completed 10 November 24

26 A3 Early Access details (including Pre-Release Access) Pre-Release Access Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access. Standard Pre-Release Access: Scottish Government Health Department NHS Board Chief Executives NHS Board Communication leads Extended Pre-Release Access Extended Pre-Release Access of 8 working days is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access). Scottish Government Health Department (Analytical Services Division) Early Access for Management Information These statistics will also have been made available to those who needed access to management information, ie as part of the delivery of health and care: Delayed Discharge Policy Manager within the Primary & Community Care Directorate, Partnership Improvement & Outcomes Division at Scottish Government. Early Access for Quality Assurance These statistics will also have been made available to those who needed access to help quality assure the publication: Delayed Discharge Policy Manager within the Primary & Community Care Directorate, Partnership Improvement & Outcomes Division at Scottish Government. 25

27 A4 ISD and Official Statistics About ISD Scotland has some of the best health service data in the world combining high quality, consistency, national coverage and the ability to link data to allow patient based analysis and follow up. Information Services Division (ISD) is a business operating unit of NHS National Services Scotland and has been in existence for over 40 years. We are an essential support service to NHSScotland and the Scottish Government and others, responsive to the needs of NHSScotland as the delivery of health and social care evolves. Purpose: To deliver effective national and specialist intelligence services to improve the health and wellbeing of people in Scotland. Mission: Better Information, Better Decisions, Better Health Vision: To be a valued partner in improving health and wellbeing in Scotland by providing a world class intelligence service. Official Statistics Information Services Division (ISD) is the principal and authoritative source of statistics on health and care services in Scotland. ISD is designated by legislation as a producer of Official Statistics. Our official statistics publications are produced to a high professional standard and comply with the Code of Practice for Official Statistics. The Code of Practice is produced and monitored by the UK Statistics Authority which is independent of Government. Under the Code of Practice, the format, content and timing of statistics publications are the responsibility of professional staff working within ISD. ISD s statistical publications are currently classified as one of the following: National Statistics (ie assessed by the UK Statistics Authority as complying with the Code of Practice) National Statistics (ie legacy, still to be assessed by the UK Statistics Authority) Official Statistics (ie still to be assessed by the UK Statistics Authority) other (not Official Statistics) Further information on ISD s statistics, including compliance with the Code of Practice for Official Statistics, and on the UK Statistics Authority, is available on the ISD website. The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics. Designation can be broadly interpreted to mean that the statistics: meet identified user needs; are well explained and readily accessible; are produced according to sound methods, and are managed impartially and objectively in the public interest. Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed. 26

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